The goal of the therapy for necrosis of the femoral head in adults is the preservation of the femoral head and, therefore, avoidance of total joint replacement. Core decompression is known to reduce the intraosseous pressure and additionally provides the opportunity to introduce bioactive materials, substances and cells into the core tract. These include vascularized and non-vascularized bone grafts, allogenic and synthetic bone substitutes, osteogenic and angiogenic growth factors, as well as different progenitor cells. In particular, the use of cell-based strategies has great therapeutic potential and could play an important role in the treatment of femoral head necrosis in adults in the future. In this article, we summarize the existing clinical experience of current cell-based strategies for the treatment of femoral head necrosis in adults, and present a therapeutic approach using bone marrow stem cells (TRCs: tissue repair cells). in combination with a beta-TCP matrix.